In this next section of our Movember men’s health series, we thought we would cover some of the treatments widely used following a prostate cancer diagnosis. Specifically, we will dive into the prostatectomy surgery and how it can contribute to pelvic floor dysfunction in men.
Prostate cancer is a condition that causes abnormal cells to develop within the prostate gland. These cells grow, divide and multiply creating a tumor. This tumor can be localized or it may spread to other parts of the body.
Depending on each case, treatment options for men with prostate cancer might include:
• Observation or active surveillance
• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy
• Immunotherapy and cryotherapy
A radical prostatectomy is often considered depending on the stage and grade of a tumor. The goal of this surgery is to remove the cancer from the body.
In a radical prostatectomy, the entire prostate gland is removed along with the surrounding tissues including lymph nodes.
There are different ways to perform a radical prostatectomy:
• Laparoscopic approach is when the prostate is removed using a special tools inserted through very small incisions.
• Robotic approach is very similar to the laparoscopic approach, but uses a mechanical device.
• Open approach where the prostate is removed through an incision in the lower abdomen or between the anus and the scrotum.
As with any surgical procedure, certain complications can occur following a radical prostatectomy.
• Urinary incontinence
• Urinary leakage or dribbling
• Erectile dysfunction
Urinary Incontinence After Radical Prostatectomy: What To Expect
After radical prostatectomy, a lot of men experience urinary incontinence. This is a common after-effect of the surgery.
Urinary incontinence after radical prostatectomy can have a huge impact on a man’s quality of life but there is some good news: bladder control can be regained in full, often within a year!
The amount of urine that leaks and how long it lasts for is unique to every man, but there is plenty of support to improve post-op urinary continence. This can include pre-op and post-op physiotherapy to increase urinary continence.
Stress incontinence is the most common type of leakage after prostate surgery. Urinary leakage can occur after coughing, sneezing, laughing, and physical activity. This can be anything from a few drops of urine to a lot more.
After a radical prostatectomy, research suggests that around 40% of men suffer from urinary incontinence. Other research indicates that as it’s often underreported, the true figure may be much higher than this.
Urinary urgency can also sometimes develop after prostate surgery. With this type of incontinence, there is a need to urinate suddenly and this can cause leakage.
Some men can develop a mixture of stress and urge urinary incontinence.
Why Is Urinary Control An Issue After The Prostate Is Removed?
Urinary incontinence after prostate surgery is a common issue and it’s strongly linked to the male anatomy.
The prostate gland is about the size of a walnut and surrounds the neck of a man’s bladder and urethra (the tube that carries the urine from the bladder). The prostate gland plays an important role in both sexual and urinary function.
There are several structures involved in controlling urination as a man. This includes the urethra, the pelvic floor muscles, and three sphincters. These sphincters are located in the bladder, prostate, and just below the prostate.
Under normal circumstances, urine is kept in the bladder by these sphincters, which remain closed until the brain signals them to open.
After a radical prostatectomy, two of the sphincters disappear and one sphincter takes on the role of the others. This makes it a lot harder to control urination in the early stages of recovery.
Why is erectile dysfunction an issue after a prostatectomy?
Two small bundles of nerves on either side of the prostate are vulnerable to injury during the operation. A type of operation called “nerve sparing” surgery may be possible. This depends on the size and location of the cancer.
Surgery may require removal of some nerves if there’s a chance the cancer has invaded one or both sets of nerves. If both sets of nerves are removed, most men will not be able to achieve an erection without the assistance of medical devices.
There are also other factors that affect ED during recovery. So, it’s difficult to predict the recovery. Injury to nerve tissue during a radical prostatectomy can cause a longer recovery.
Improvements in prostate surgery techniques have led to much better outcomes for many men. Healthier erectile function before surgery can also help predict a better outcome. The Prostrate Cancer Foundation reports that about half of men who undergo nerve-sparing surgery will regain their pre-surgery function within the first year after surgery.
Next week, we will be highlighting the various ways that physiotherapy can help before and after prostate surgery. Stay tuned!
For more info:
Incontinence after radical prostatectomy: Anything new in its management?
